Epidural and Resuscitation Errors in the News
Following an agonizing labor, Mrs. Singh opted to receive an epidural to help relieve her pain during delivery. Singh’s anesthesiologist first performed a spinal block so she would sit still enough to have the epidural; consequently, this amounted to a double dose of anesthesia. After anesthesia administration, the medical team did not utilize any type of fetal monitor so the baby’s heart rate could be monitored and fetal distress noticed. In fact, both the mother and baby were not monitored at all after anesthesia had been given. Singh was numb from the waist down and thus did not realize that her baby was being born under the sheets. Nobody knows exactly what time the baby boy was born. His birth was finally noticed when the medical team came to place the fetal heart monitor and check the progress of Singh’s labor. When the baby boy was found “suffocating under the sheets,” he was in very poor condition. Baby Maninder Singh was given resuscitation upon the discovery of his birth, but it was too late. He developed severe brain damage as result of the oxygen deprivation (anoxia) and had on-going respiratory problems. Maninder remained in intensive care and several days later, the little boy passed away.
The hospital in which Maninder was born released the following statement:
“We have recognized there were failings surrounding the care of Maninder Singh, and we accept that this fell below the level of care we normally provide; as a result we have reviewed our practices and systems and implemented a number of changes.”
When a baby or child suffers from debilitating conditions or death, it is devastating. But when the damage to the baby could easily have been prevented, it is especially tragic. When a baby experiences oxygen-depriving events, the anoxia can cause severe brain injuries, such as cerebral palsy, hypoxic ischemic encephalopathy (HIE), seizure disorders and intellectual and developmental delays.
Improper Medication Administration During Labor
Anesthesiologists must make very specific calculations when administering medications to women, especially when performing an epidural. Anesthesiologists must ensure that the correct amount and type of anesthesia is given, and that it is administered properly. In addition, close monitoring is required when anesthesia is given to a pregnant woman. Even a minor deviation from the correct procedure can cause permanent injury to the mother or child.
Sedatives and narcotics can be used early in labor to minimize pain and relax the expectant mother. Fentanyl, morphine sulfate and Demerol frequently are used. These medications can cause complications, such as respiratory depression and increased risk of aspiration in the baby (such as inhaling meconium, which is amniotic fluid mixed with stool). These drugs should not be given close in time to the expected delivery.
A pudendal block is an anesthetic, similar to lidocaine, injected into the pudendal nerve (a nerve in the pelvic region). This procedure is often used when delivery occurs by forceps or vacuum; it also is used just before an epesiotomy. It is usually given during the second stage of labor, just prior to delivery. There always is some risk that the anesthesia can cross the placenta and enter the baby’s bloodstream. Local anesthesia is commonly used for mothers who did not use anesthesia for delivery but who require an episiotomy, which is a surgically planned incision on the perineum and vaginal wall during the second stage of labor.
An epidural is used to decrease the pain associated with childbirth. It is usually administered during the active phase of labor, and is inserted into the space between L3 and L4 in the spine (in the lower back). The amount of medication can be increased if a C-section delivery is required.
Anesthesiologists are taught to perform epidurals by a process known as “The Four P’s.” These are preparation (the doctor must use the correct needle and type/dose of medicine), position (the patient must be properly positioned – for a woman in labor, this is usually on her side), projection (the needle must be properly placed at the expected insertion point) and puncture (the needle must penetrate the spinal column without entering the spinal sac). If not properly performed, the mother can suffer from the following injuries:
- Nerve damage
- Cardiac arrest
- Difficulty breathing
Additionally, errors can cause injuries to the baby, such as the following:
- Brain injury, such as cerebral palsy and HIE
General and spinal anesthesia are often used for C-section deliveries. One complication linked to spinal anesthesia is low maternal blood pressure, which can cause low heart rate in the baby. General anesthesia is more frequently used for emergency C-sections. The risks of general anesthesia include the following:
- Placental abruption
- Low heart rate for the baby
- Umbilical cord prolapse
- Uterine rupture
- Placenta previa
In addition to the aforementioned risks and complications, any anesthesia that does not allow the mother to properly convey what she is feeling during labor poses a risk to the baby. In Mrs. Singh’s case, she couldn’t feel anything and thus didn’t notice when her baby had crowned or been born. A mother and baby should be closely monitored during labor and delivery, and this is especially true when anesthesia is given.
Failure to Properly Monitor Mother and Baby During Delivery
An electronic fetal monitor records the mother’s contractions and the baby’s heart beat in response to contractions. When a fetal heart monitor is nonreassuring, it means that the baby is in distress and is not getting enough oxygen (called hypoxia), and prompt and appropriate actions must be taken. In fact, a nonreassuring fetal heart tracing is often the only indication that a baby is in distress. Had baby Maninder been monitored with a fetal heart monitor, the medical team would have been alerted the instant he was in distress.
Fetal Resuscitation Errors
Resuscitation is performed on a baby to correct breathing problems and failure to breathe, heart beat cessation or significant irregularities, and/or very low blood pressure. These are all life-threatening conditions that can severely deprive a baby’s brain of oxygen. Thus it is critical that at every birth, a skilled team be immediately available to help resuscitate the baby, should the need arise. When a baby is considered “high risk,” it is recommended that a resuscitation team be in the room for the baby’s birth.
During resuscitation, the team may do one or more of the following:
- Put a breathing tube in the baby’s upper airway, called intubation, so that a machine, called a ventilator, can breathe for the baby.
- Place a mask over the baby’s nose and mouth and give the baby breaths by using an inflatable bag, which is a bag that the team squeezes to force air into the baby’s lungs.
- Perform chest compressions on the baby in order to increase a very slow heart rate or to restart a heart. Compressions help the heart disperse blood to important organs, such as the brain, to help prevent permanent injury.
- Give the baby’s heart an electrical shock, called defibrillation, in an attempt to restore normal heart rhythm.
- Give the baby drugs, such as epinephrine, to increase the amount of blood pumped out by the heart per minute.
- Give the baby drugs or blood in order to increase the baby’s blood pressure.
These life saving maneuvers also can cause serious complications in a baby if not properly performed. It therefore is crucial that the resuscitation team be able to perform them quickly and skillfully.
Anesthesia, Monitoring and Resuscitation Mistakes | Medical Malpractice
In Mrs. Singh and baby Maninder’s case, there were failures on multiple levels. First of all, it appears as though Mrs. Singh was given an inappropriate and dangerous amount of anesthesia since she was numb from the waist down and could not feel her baby being born. In addition, a situation in which this type and amount of anesthesia is given requires very close monitoring of the mother and baby. A fetal heart monitor should have been used for baby Maninder so that fetal distress could have immediately been detected. Finally, hospitals that deliver babies must have the staff and equipment to perform immediate and proper resuscitation for those who need it. When a mother has had a prolonged labor, the baby is in a high risk situation and a resuscitation team should be in the room at the time of delivery in case the baby needs help with her heart or breathing.
Failure to follow any of these standards of care is negligence. If this negligence leads to injury of the baby, it is medical malpractice.
Due to the complex nature of birth injury cases, it is imperative to have skilled and experienced attorneys. At Reiter & Walsh ABC Law Centers, our attorneys will research your case, find the cause of injury and determine if negligence occurred. For decades, we have been helping families in Michigan and throughout the nation, and we have numerous multi-million dollar verdicts that attest to our success. We will fight to obtain the compensation you and your family deserve for lifelong care, treatment and therapy of your child, and you never pay any money until we win your case. Call us at 888-419-2229.